Most Relevant Information
Provider Data
| NPI Number: | 1003677964 |
| Provider Name: | AUTUMN AXLINE PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/18/2024 |
| Last Updated: | 01/18/2024 |
Provider Practice Location
211 N EDDY ST
SOUTH BEND
IN
466172808
Practice Location Phone/Fax
| Phone: | 5742348161 |
| Fax: |
Provider Mailing Location
26621 HAMILTON ST
EDWARDSBURG
MI
491129691
Provider Mailing Phone/Fax
| Phone: | 5748559892 |
| Fax: |